Obamacare the Train that keeps not Wrecking

[JeffreyS]

Remember 2010 Republicans saying that the CBO was underestimating the cost of Obamacare now after having already having to lower it's cost estimate once it looks like the CBO is going to have to lower it's estimates again. Obamacare turns out costs less and covers more than anyone predicted it would.

President Barack Obama has not had a good couple of weeks. His foreign policy is going badly, his legislative agenda is stalled, and his party looks likely to lose the Senate. He's entering the traditional lame-duck years of a presidency and further accomplishments appear increasingly remote.

But less than 10 months after major media outlets were hosting debates with headlines like "Is the Affordable Care Act Beyond Repair?", Obama's signature accomplishment is succeeding beyond all reasonable expectation.
A new report from the Kaiser Family Foundation finds that in seven major cities that have released data on 2015 premiums, the price of the benchmark Obamacare plan — the second-cheapest silver plan, which the federal government uses to calculate subsidies —  is falling.

Yes, falling.

"Falling" is not a word that people associate with health-insurance premiums. They tend to rise as regularly as the morning sun. And, to be fair, the Kaiser Family Foundation is only looking at 16 cities in 15 states and the District of Columbia, and the drop they record is, on average, a modest 0.8 percent (though this is the same methodology they used in 2014, and to good results). But this data, though preliminary, is the best data we have  —  and it shows that Obamacare is doing a better job holding down costs than anyone seriously predicted, including Kaiser's researchers.

"I expected premium growth to be modest in most of the country," Larry Levitt, a co-author of the report, told Vox's Sarah Kliff. "But what we saw were some decreases instead."

Obamacare's surprising successes

Obamacare is doing better at a lot of things than anyone seriously expected. The law's initial premiums came in cheaper than the Congressional Budget Office projected when the law first passed. In April 2014, the Congressional Budget Office said the unexpectedly low premiums meant Obamacare would cost $104 billion less than they previously thought. If Kaiser's estimates hold nationally, Obamacare's cost will have to be revised downward yet again.

The fear about government programs in general, and government health-insurance programs in particular, is that they are overly generous because they spend other people's money. But Obamacare's competitive insurance marketplaces are actually doing what they promised to do: forcing insurers to compete for customers by cutting costs. The Congressional Budget Office explains that Obamacare's premiums are cheaper-than-expected because its insurance features "lower payment rates for providers, narrower networks of providers, and tighter management of their subscribers' use of health care than employment-based plans do."

That is something of an extraordinary statement: Obamacare is forcing insurers to run leaner than employers are. The CBO is so surprised by this that it basically refuses to believe it will last. They expect that Obamacare "will not be able to sustain provider payment rates that are as low or networks that are as narrow as they appear to be in 2014," though they think it will continue to run leaner than employer-based insurance. And perhaps that's right. But CBO has underestimated the law before, and the addition of more insurers into the marketplace, and more customers into the marketplace, should mean even more pressure for lower prices.

Obamacare's premiums aren't its only victory. The law, despite its famously disastrous launch, beat expectations and enrolled 8 million people in its insurance exchanges. In part for that reason, more insurers are joining Obamacare's exchanges, which will increase competition and put even more downward pressure on prices. All that speaks to the subsidized private insurance Obamacare offers through its exchanges, but Obamacare's Medicaid expansion is, well, expanding too; Pennsylvania's Republican governor signed his state up just this week.

All this is happening amidst some genuinely remarkable news for spending in government health-insurance programs generally. Medicare's per-enrollee spending is actually going down —  a string of words I never thought I'd write in that particular order.

This is, as Vice President Joe Biden might say, a big fucking deal. As Margot Sanger-Katz and Kevin Quealy write at the Upshot, the reductions in projected Medicare spending for 2019 are, at this point, "greater than [what] the government is expected to spend that year on unemployment insurance, welfare and Amtrak  —  combined." It's not clear to what degree Obamacare's manifold efforts to save money in Medicare are contributing to those falling costs, as the trend predates the law. But many health economists do think Obamacare is contributing on the margin, and either way, it's more evidence that the federal government is figuring out how to run a tighter health-care ship.
Imagine taking a time machine back to 2010 and telling Republicans in Congress, who were arguing that the CBO was wildly underestimating Obamacare's cost, that the law would be cheaper than predicted and, at least in the states that accepted its Medicaid dollars, cover more people than the Congressional Budget Office thought. After the laughing and mocking and the calling of security, let's say you offered this prediction in the form a of a bet. What odds do you think Obamacare's critics would have offered? 2:1? 5:1? 10:1?

Or imagine it played out the other way. Imagine that Obamacare's 2014 premiums had come in higher than expected, and its 2015 premiums were growing even faster than projected. Imagine it had signed up 6 million people rather than 7 million people. Imagine Medicare costs were exploding. What would Fox News be saying about Obamacare right now? What would the Wall Street Journal editorial board be writing?

Obamacare has been a political failure for the Democrats — and, frankly, a political failure period. Its passage was a bitter, polarizing war; its launch was multi-month catastrophe; and the law remains unpopular even today. But the law is quietly losing its toxicity: fewer members of Congress are running against it, and Republican policy elites are actively trying to persuade their party to give up on repeal and instead "transcend" Obamacare — which is to say, use it as a platform for their own health-care ideas. This is in part because voters seems to be moving on: Aaron Blake notes that Obamacare now ranks behind "other" in polls asking Americans why the country is off-track.

The electorate moving on means Obamacare's mounting achievements don't get nearly the attention of its early failures. But the law, at this point, is doing more than simply defying the doomsayers; it's proving to be a real policy success.


http://www.vox.com/2014/9/5/6108493/obamacare-premiums-lower-2015

[Ocklawaha]

[img]http://cdn2.vox-

Or imagine it played out the other way. Imagine that Obamacare's 2014 premiums had come in higher than expected, and its 2015 premiums were growing even faster than projected. Imagine it had signed up 6 million people rather than 7 million people. Imagine Medicare costs were exploding. What would Fox News be saying about Obamacare right now? What would the Wall Street Journal editorial board be writing?

What a joke! I'm guessing the DOUBLING of my federal group medical insurance premium is an allusion?  And there are an estimated 20M 'me's' out there which is going to cost 'the real party of the rich, dearly.'

DELUDED! ...And yes I voted for 'Dear Leader,' a hell of a mistake.

He is positioning us for Mid-East invasion/war number 3... you know, because the other two turned out so good! Of course this one will be righteous because it's Obama and it's not big oil! LOL!

Then of course Mr. Clean has racked up a few other disappointments which are easily googled:

1. IRS targets Obama’s enemies: The IRS targeted conservative and pro-Israel groups prior to the 2012 election. Questions are being raised about why this occurred, who ordered it, whether there was any White House involvement and whether there was an initial effort to hide who knew about the targeting and when.

2. Benghazi: This is actually three scandals in one:

The failure of administration to protect the Benghazi mission.
The changes made to the talking points in order to suggest the attack was motivated by an anti-Muslim video
The refusal of the White House to say what President Obama did the night of the attack

3. Watching the AP: The Justice Department performed a massive cull of Associated Press reporters’ phone records as part of a leak investigation.

4. Rosengate: The Justice Department suggested that Fox News reporter James Rosen is a criminal for reporting about classified information and subsequently monitored his phones and emails.

5. Potential Holder perjury I: Attorney General Eric Holder told Congress he had never been associated with “potential prosecution” of a journalist for perjury when in fact he signed the affidavit that termed Rosen a potential criminal.

6. The ATF “Fast and Furious” scheme: Allowed weapons from the U.S. to “walk” across the border into the hands of Mexican drug dealers. The ATF lost track of hundreds of firearms, many of which were used in crimes, including the December 2010 killing of Border Patrol Agent Brian Terry.

7. Potential Holder Perjury II: Holder told Congress in May 2011 that he had just recently heard about the Fast and Furious gun walking scheme when there is evidence he may have known much earlier.

8. Sebelius demands payment: HHS Secretary Kathleen Sebelius solicited donations from companies HHS might regulate. The money would be used to help her sign up uninsured Americans for ObamaCare.

9. The Pigford scandal: An Agriculture Department effort that started as an attempt to compensate black farmers who had been discriminated against by the agency but evolved into a gravy train delivering several billion dollars in cash to thousands of additional minority and female farmers who probably didn’t face discrimination.

10. GSA gone wild: The General Services Administration in 2010 held an $823,000 training conference in Las Vegas, featuring a clown and a mind readers. Resulted in the resignation of the GSA administrator.

11. Veterans Affairs in Disney World: The agency wasted more than $6 million on two conferences in Orlando. An assistant secretary was fired.

12. Sebelius violates the Hatch Act: A U.S. special counsel determined that Sebelius violated the Hatch Act when she made “extemporaneous partisan remarks” during a speech in her official capacity last year. During the remarks, Sebelius called for the election of the Democratic candidate for governor of North Carolina.

13. Solyndra: Republicans charged the Obama administration funded and promoted its poster boy for green energy despite warning signs the company was headed for bankruptcy. The administration also allegedly pressed Solyndra to delay layoff announcements until after the 2010 midterm elections.

14. AKA Lisa Jackson: Former EPA Administrator Lisa Jackson used the name “Richard Windsor” when corresponding by email with other government officials, drawing charges she was trying to evade scrutiny.

15. The New Black Panthers: The Justice Department was accused of using a racial double standard in failing to pursue a voter intimidation case against Black Panthers who appeared to be menacing voters at a polling place in 2008 in Philadelphia.

16. Waging war all by myself: Obama may have violated the Constitution and both the letter and the spirit of the War Powers Resolution by attacking Libya without Congressional approval.

17. Biden bullies the press: Vice President Biden’s office has repeatedly interfered with coverage, including forcing a reporter to wait in a closet, making a reporter delete photos, and editing pool reports.

18. AKPD not A-OK: The administration paid millions to the former firm of then-White House adviser David Axelrod, AKPD Message and Media, to promote passage of Obamacare. Some questioned whether the firm was hired to help pay Axelrod $2 million AKPD owed him.

19. Sestak, we’ll take care of you: Former White House Chief of Staff Rahm Emanuel used Bill Clinton as an intermediary to probe whether former Rep. Joe Sestak (D-Pa.) would accept a prominent, unpaid White House advisory position in exchange for dropping out of the 2010 primary against former Sen. Arlen Specter (D-Pa.).

20. I’ll pass my own laws: Obama has repeatedly been accused of making end runs around Congress by deciding which laws to enforce, including the decision not to deport illegal immigrants who may have been allowed to stay in the United States had Congress passed the “Dream Act.”

21. The hacking of Sharyl Attkisson’s computer: It’s not clear who hacked the CBS reporter’s computer as she investigated the Benghazi scandal, but the Obama administration and its allies had both the motive and the means to do it.

22. An American Political Prisoner: The sudden decision to arrest Nakoula Basseley Nakoula on unrelated charges after protests in the Arab world over his anti-Muslim video is an extraordinarily suspicious coincidence. “We’re going to go out and we’re going to prosecute the person that made that video,” Hillary Clinton allegedly told the father of one of the ex-SEALs killed in Banghazi.

23. Get rid of inconvenient IGs: Corporation for National and Community Service Inspector General Gerald Walpin was fired in 2009 as he fought wasteful spending and investigated a friend of Obama’s, Sacramento Mayor and former NBA player Kevin Johnson. The White House says Walpin was incompetent.

24. Influence peddling: An investigation is underway of Alejandro Mayorkas, director of the U.S. Citizenship and Immigration Services, who has been nominated by Obama for the number two post at the Department of Homeland Security. Mayorkas may have used his position to unfairly obtain U.S. visas for foreign investors in company run by Hillary Clinton’s brother, Anthony Rodham.
http://www.whitehousedossier.com/2013/08/01/obama-dozen-scandals-counting/

I'd toss in the STUPID WASTE of dollars on his failed High Speed Rail program which was never realistic, never really planned (the routes changed daily), never ready for a shovel (except maybe in Florida which was a dog of a project mercifully put down by Governor Scott) and never executed 'as advertised' anywhere. At best all they did was slightly increase track speeds in Illinois and Michigan, then dump a few million? billion? more in the NEC, because, you know, that's the only place in America where 'trains make money...'

I can make you a deal on the Dames Point and the Matthews bridge, 2 for the price of 1.

[finehoe]

I'm guessing the DOUBLING of my federal group medical insurance premium is an allusion? 

Perhaps it is designed to call something to mind without mentioning it explicitly, but since Federal employees, retirees and their survivors enjoy the widest selection of health plans in the country, just pick another plan more to your liking.  That's more than most people can do.

[Ocklawaha]

I get a choice of two PPO, several traditional 'pay for service,' and no HMO's in Jacksonville (some Florida cities have HMO's among their choices, which go by region as opposed to national). I think Orlando residents get to choose a couple of HMO's, in any case I'm in the cheapest plan offered in the program! Sucks! Basically I either choose BCBS (Blue Cross) or GEHA (Government Employees Health Association). Blue Cross is considerably more but the service level is about even. The other 'catch' is I'm 100% disabled which disqualifies me for many typical 'retiree benefits.'

As it stands right now, under the new Obama plans and rates, it's cheaper for me to buy a round trip ticket, fly to Medellin, and use my Colombian citizen Colpatria Insurance plan which unlike Obama Care, let's you keep your doctor, keep your health care plan... etc.  http://www.axacolpatria.co/portal/Salud/PortalSalud/Empresas/MedicinaPrepagada/tabid/137/ArticleId/88/Informacion-General.aspx

[finehoe]

... and use my Colombian citizen Colpatria Insurance plan which unlike Obama Care, let's you keep your doctor, keep your health care plan... etc. 

Wouldn't that make you a Socialist?

[JeffreyS]

Anecdotes aside here is Krugeman's take on the actual data.

 
The Obamacare life Spiral
Ezra Klein directs us to the latest from the Kaiser Family Foundation, which asks what the average Obamacare 2015 premium increase will be for those places for which we have full information — and finds that premiums will actually decline slightly. Ezra tries to get us to appreciate just how good the Obamacare news has been with a thought experiment:

Imagine taking a time machine back to 2010 and telling Republicans in Congress, who were arguing that the CBO was wildly underestimating Obamacare’s cost, that the law would be cheaper than predicted and, at least in the states that accepted its Medicaid dollars, cover more people than the Congressional Budget Office thought. After the laughing and mocking and the calling of security, let’s say you offered this prediction in the form a of a bet. What odds do you think Obamacare’s critics would have offered? 2:1? 5:1? 10:1?

But you don’t have to go back to 2010. Look at John Cochrane in late 2013, taking it for granted that Obamacare would implode in a death spiral within a few months. Look at The Hill just four months ago, telling us that double-digit premium hikes were coming.

One question we might ask here is, why is the news so good? The answer, I’d suggest — although I hope the real experts will weigh in — is that we’re actually seeing the opposite of a death spiral; call it a life spiral. For one thing, the huge surge in enrollments late in the day meant that the risk pool this year is better than insurers expected, and they now expect 2015 to be better still. Also, importantly, big enrollments mean that more insurers are entering the market, increasing competition. And, of course, the better the deal the more people will sign up: success feeds success.

Another question we might ask: Is our conservatives learning? Are those who bought into the death spiral stories, who seized on every hint of bad news, asking themselves how they got it so wrong? Are they, maybe, considering the possibility that they’re listening to the wrong people, that maybe Jon Gruber knows what he’s talking about and John Goodman is a hack?

Hahahaha.

http://krugman.blogs.nytimes.com/2014/09/05/obamacare-life-spiral/?_php=true&_type=blogs&_r=0

[Ocklawaha]

... and use my Colombian citizen Colpatria Insurance plan which unlike Obama Care, let's you keep your doctor, keep your health care plan... etc. 

Wouldn't that make you a Socialist?

Not likely, it would make me Colombian! Colombia is not a socialist country, nor it's national health mandates, the insurance at Colpatria (my carrier) is just one of dozens of private companies.

[finehoe]

Not likely, it would make me Colombian! Colombia is not a socialist country, nor it's national health mandates, the insurance at Colpatria (my carrier) is just one of dozens of private companies.

But they have universal health care, which to US conservatives equals "socialized medicine". 

http://content.healthaffairs.org/content/28/3/853.full

[finehoe]

In Columbia:

Because prices and benefits are both determined by the government, any competition among insurers would be expected to be on the basis of quality. The insurer contracts for health services with a network of public, private, or own-service providers (providers that are owned by the insurers themselves). The government sets a unique premium with risk adjustment by age, sex, and location, to be paid to all insurers for each beneficiary.

LOL.  "Keep you government hands off my medicare!"

[Ocklawaha]

Everything in Colombia (note the spelling) is adjusted by 'by age, sex, and location.' Outside of totalitarian communist or fascist regime, this is the easiest way to thwart a revolution by those who have absolutely nothing. By building these 'stair steps' into rents, utilities, transit fares, medical and other social services, everything remains private enterprise. The stepped plans are intended to be a temporary hand-up, not a hand-out. There is something of a stigma for being in a 0-2 zone (6 is the top, where a typical US citizen would live) and people work very hard to get themselves up and out of those situations. Currently the country is struggling under a completely shattered border (not unlike our own) with millions of Venezuelans pouring through to escape the 'workers paradise' Chavez created. The United States doesn't have poverty, anyone that doesn't believe it should spend some time traveling around the globe. I would sum it up saying it's not Obama care, it's not socialism, but it is a fix that appears to be working without a 'Dear Leader,' or 'IRS enforcers.'

[finehoe]

I would sum it up saying it's not Obama care, it's not socialism, but it is a fix that appears to be working without a 'Dear Leader,' or 'IRS enforcers.'

Nonetheless, it's pretty funny that you would praise a system where the government sets the prices and benefits of the healthcare system as superior to "socialistic" Obamacare.

[PeeJayEss]

1. IRS targets Obama’s enemies: The IRS targeted conservative and pro-Israel groups prior to the 2012 election. Questions are being raised about why this occurred, who ordered it, whether there was any White House involvement and whether there was an initial effort to hide who knew about the targeting and when.

2. Benghazi: This is actually three scandals in one:

The failure of administration to protect the Benghazi mission.
The changes made to the talking points in order to suggest the attack was motivated by an anti-Muslim video
The refusal of the White House to say what President Obama did the night of the attack

3. Watching the AP: The Justice Department performed a massive cull of Associated Press reporters’ phone records as part of a leak investigation.

4. Rosengate: The Justice Department suggested that Fox News reporter James Rosen is a criminal for reporting about classified information and subsequently monitored his phones and emails.

5. Potential Holder perjury I: Attorney General Eric Holder told Congress he had never been associated with “potential prosecution” of a journalist for perjury when in fact he signed the affidavit that termed Rosen a potential criminal.

6. The ATF “Fast and Furious” scheme: Allowed weapons from the U.S. to “walk” across the border into the hands of Mexican drug dealers. The ATF lost track of hundreds of firearms, many of which were used in crimes, including the December 2010 killing of Border Patrol Agent Brian Terry.

7. Potential Holder Perjury II: Holder told Congress in May 2011 that he had just recently heard about the Fast and Furious gun walking scheme when there is evidence he may have known much earlier.

8. Sebelius demands payment: HHS Secretary Kathleen Sebelius solicited donations from companies HHS might regulate. The money would be used to help her sign up uninsured Americans for ObamaCare.

9. The Pigford scandal: An Agriculture Department effort that started as an attempt to compensate black farmers who had been discriminated against by the agency but evolved into a gravy train delivering several billion dollars in cash to thousands of additional minority and female farmers who probably didn’t face discrimination.

10. GSA gone wild: The General Services Administration in 2010 held an $823,000 training conference in Las Vegas, featuring a clown and a mind readers. Resulted in the resignation of the GSA administrator.

11. Veterans Affairs in Disney World: The agency wasted more than $6 million on two conferences in Orlando. An assistant secretary was fired.

12. Sebelius violates the Hatch Act: A U.S. special counsel determined that Sebelius violated the Hatch Act when she made “extemporaneous partisan remarks” during a speech in her official capacity last year. During the remarks, Sebelius called for the election of the Democratic candidate for governor of North Carolina.

13. Solyndra: Republicans charged the Obama administration funded and promoted its poster boy for green energy despite warning signs the company was headed for bankruptcy. The administration also allegedly pressed Solyndra to delay layoff announcements until after the 2010 midterm elections.

14. AKA Lisa Jackson: Former EPA Administrator Lisa Jackson used the name “Richard Windsor” when corresponding by email with other government officials, drawing charges she was trying to evade scrutiny.

15. The New Black Panthers: The Justice Department was accused of using a racial double standard in failing to pursue a voter intimidation case against Black Panthers who appeared to be menacing voters at a polling place in 2008 in Philadelphia.

16. Waging war all by myself: Obama may have violated the Constitution and both the letter and the spirit of the War Powers Resolution by attacking Libya without Congressional approval.

17. Biden bullies the press: Vice President Biden’s office has repeatedly interfered with coverage, including forcing a reporter to wait in a closet, making a reporter delete photos, and editing pool reports.

18. AKPD not A-OK: The administration paid millions to the former firm of then-White House adviser David Axelrod, AKPD Message and Media, to promote passage of Obamacare. Some questioned whether the firm was hired to help pay Axelrod $2 million AKPD owed him.

19. Sestak, we’ll take care of you: Former White House Chief of Staff Rahm Emanuel used Bill Clinton as an intermediary to probe whether former Rep. Joe Sestak (D-Pa.) would accept a prominent, unpaid White House advisory position in exchange for dropping out of the 2010 primary against former Sen. Arlen Specter (D-Pa.).

20. I’ll pass my own laws: Obama has repeatedly been accused of making end runs around Congress by deciding which laws to enforce, including the decision not to deport illegal immigrants who may have been allowed to stay in the United States had Congress passed the “Dream Act.”

21. The hacking of Sharyl Attkisson’s computer: It’s not clear who hacked the CBS reporter’s computer as she investigated the Benghazi scandal, but the Obama administration and its allies had both the motive and the means to do it.

22. An American Political Prisoner: The sudden decision to arrest Nakoula Basseley Nakoula on unrelated charges after protests in the Arab world over his anti-Muslim video is an extraordinarily suspicious coincidence. “We’re going to go out and we’re going to prosecute the person that made that video,” Hillary Clinton allegedly told the father of one of the ex-SEALs killed in Banghazi.

23. Get rid of inconvenient IGs: Corporation for National and Community Service Inspector General Gerald Walpin was fired in 2009 as he fought wasteful spending and investigated a friend of Obama’s, Sacramento Mayor and former NBA player Kevin Johnson. The White House says Walpin was incompetent.

24. Influence peddling: An investigation is underway of Alejandro Mayorkas, director of the U.S. Citizenship and Immigration Services, who has been nominated by Obama for the number two post at the Department of Homeland Security. Mayorkas may have used his position to unfairly obtain U.S. visas for foreign investors in company run by Hillary Clinton’s brother, Anthony Rodham.
http://www.whitehousedossier.com/2013/08/01/obama-dozen-scandals-counting/

Sweet list of completely accurate accusations from a totally reliable source! 

DELUDED!

Indeed